Upper respiratory tract diseases: drugs of choice. How is a child's respiratory tract infection treated? Diseases of the upper respiratory tract

29.09.2020

46-47 DISEASES OF THE RESPIRATORY ORGANS

In children, respiratory diseases are much more common than in adults, and are more severe, due to the peculiarities of the anatomical and physiological characteristics of children and the state of immunity.

Anatomical features

Respiratory organs are divided into:

1.Upper respiratory tract (DP): nose, pharynx.

3. Lower DP: bronchi and lung tissue.

Respiratory diseases

Upper respiratory tract diseases: rhinitis and tonsillitis are most common.

Angina - an infectious disease in which the palatine

tonsils. The causative agent is most often streptococcus and viruses.

Distinguish between acute and chronic angina.

The clinical picture of acute angina:

Intoxication symptoms: lethargy, muscle pain, lack of appetite.

Fever

Pain when swallowing

The appearance of plaque on the tonsils

Principles of therapy:

Antibacterial therapy! (The drug of choice is penicillin (amoxicillin)).

Abundant drink (V \u003d 1.5-2 l)

Vitamin C

Gargling with disinfectant solutions.

The clinical picture of chronic tonsillitis:

The main symptom: repeated exacerbations of angina.

Symptoms of intoxication may be present, but less severe

Frequent nasal congestion

Bad breath

Frequent infections

Long subfebrile condition

Principles of therapy:

Washing lacunae, tonsils with antiseptic solutions (course 1-2 r / year).

Local antiseptics: ambazon, gramicidin, hepsetidin, falimint.

General strengthening activities

Regular spa treatment

Vitamin-rich nutrition (Vit. C at a dose of 500 mg per day)

Herbal medicine: tonsilgon for children 10-15 drops x 5-6 r / day for 2-3 weeks.

Acute rhinosinusitis - an infectious disease, the causative agent is most often viruses. Depending on the type of pathogen, rhinosinusitis is divided into catarrhal (viral) and purulent (bacterial).

Clinical picture:

Difficulty in nasal breathing

Headache

Discharge from the nose (can be mucous - with a viral infection, and purulent - with bacterial).

Less common: increased body temperature, cough

Therapy principles:

With a mild course, in the early stages of the disease, rinsing the nose with a warm solution (saline, furatsilin), hot foot baths, moisturizing sprays (to thin mucus) - Aquamoris or mucolytic agents are effective.

Mucolytic drugs: rinofluimucil for 7-10 days.

Vasoconstrictor drugs are prescribed for a period of no more than 7-10 days.

With viral rhinitis in severe cases, bioparox is effective.

Antibacterial drugs are prescribed only in the presence of purulent discharge (the drug of choice is amoxicillin, in the presence of allergy to penicillin - sumamed (macropen)).

Diseases of the middle respiratory tract

Laryngotracheitis is the most common lesion of the SDP.

Acute laryngotracheitis - an acute illness, the causative agent of which is most often viruses, but may be allergens.

Clinical picture:

Sudden onset, often at night

Noisy wheezing and shortness of breath

Less commonly: increased body t

Therapy principles:

Distracting therapy (hot foot baths, mustard plasters for the calf muscles, abundant warm drinks).

The air in the room should be cool and humid.

Inhalation of bronchodilators (ventolin) through a nebulizer.

If there is no effect - hospitalization of the patient.

Lower respiratory tract diseases

The most common URT lesions are:

Airway obstruction

Bronchitis

Pneumonia

Bronchial asthma

Obstructive bronchitis appear more often in children of the first 2 years of life

due to the anatomical features of the airways: narrow

the lumen of the bronchi. Obstruction is associated with either a narrowing of the lumen or a blockage of the airways with thick sputum. Viruses are the causative agent in 85%.

Clinical picture:

At the onset of the disease, the clinic has an acute respiratory illness (runny nose, malaise, there may be a temperature). Later, a cough joins: at the beginning dry, but then turning into wet. Subsequently

shortness of breath appears, characterized by difficulty breathing in and out

with a characteristic whistling, pecking breath or noise heard on

distance, rapid breathing, retraction of all yielding places

chest (jugular fossa, intercostal spaces).

Therapy principles:

In case of mild course, outpatient treatment:

Frequent ventilation of the room

Inhalation through a nebulizer or spacer with bronchodilators:

berodual, ventolin, soda-salt inhalations.

Bronchial drainage and vibration massage

Acute bronchitis - characterized by inflammation of the bronchial mucosa and accompanied by hypersecretion of mucus. The most common cause of the disease is viruses.

Clinical picture:

In the first days of the illness, the ARI clinic: malaise, runny nose, there may be an increase in body temperature

Dry cough, subsequently (after 2-5 days) is moistened

Therapy principles:

Plentiful warm drink (mineral water, decoction of expectorant herbs)

With a dry, hacking cough - antitussives (libexin, sinekod)

Mustard plasters, cans are not shown (because they injure the skin and can cause an allergic reaction).

Acute pneumonia - an infectious disease in which inflammation of the lung tissue occurs. The causative agent in 80-90% is bacterial flora, much less often - viruses or fungi.

Clinical picture:

Symptoms of intoxication are expressed: body t\u003e 38-39, lasting more than 3 days; lethargy, weakness,

There may be vomiting, abdominal pain

Lack of appetite

Rapid breathing (shortness of breath) without signs of obstruction.

Principles of therapy

For mild forms, treatment can take place on an outpatient basis; in severe cases, as well as for children under 3 years of age, hospitalization is indicated:

Antibiotic therapy: Amoxicillin is the drug of choice for mild forms.

Expectorants (ambroxol, lazolvan, acetylcysteine)

Abundant drink (mineral water, fruit drink, decoctions).

Bed rest in the early days of illness

From the fifth day of illness - breathing exercises

Vitamins (aevit, vit. C)

Physiotherapy

Bronchial asthma Is a chronic allergic airway disease characterized by recurrent attacks of shortness of breath or suffocation. In the vast majority of cases, the cause of the disease is allergens. Factors that aggravate the effect of causal factors are: SARS, tobacco smoke, strong odors, cold air, exercise, food colors and preservatives.

Clinical picture:

Shortness of breath associated with wheezing

Dry, paroxysmal cough

Possibly sneezing, nasal congestion

Usually worsening worsens over several hours or

days, sometimes within minutes.

In addition to the classic signs of bronchial asthma, there are probable signs of the disease:

Having frequent episodes of paroxysmal cough and wheezing

Lack of a positive effect from the conducted antibacterial

Coughing at night

Seasonality of symptoms

Identifying family allergies

The presence of other allergic reactions in the child (diathesis)

Principles of therapy

Preventive therapy is the prevention of exacerbation attacks, i.e. elimination of contact with the allergen;

Symptomatic therapy includes the appointment of prophylactic or anti-inflammatory drugs;

Pathogenetic therapy - is aimed at the cause of the disease, i.e. if elimination of the allergen is impossible, then specific immunotherapy (allergy vaccination) is indicated.

The main cause of most acute and chronic respiratory diseases is inflammatory processes of an infectious nature, most often caused by viruses and bacteria.

Viral and bacterial infections

Viral infection... Viruses are a special type of tiny (much smaller than microbes) non-cellular particles, consisting only of nucleic acid (genetic material DNA or RNA) and a protein coat.

From nucleic acids and proteins, new viral particles are assembled and released by destruction of the host cell. Newborn viruses infect more and more cells, causing the progression of the disease, and are released into the environment, infecting new hosts.

Ways of transmission of viral infection

airborne
oral
hematogenous (through blood)
alimentary (with food)
contact
sexual

Bacterial infection... Bacteria are single-celled organisms. Unlike viruses, they are able to reproduce on their own (most often by division) and have their own metabolism. Bacteria use the "host" only as a food product and a fertile environment for life and reproduction.

Many bacteria that are normally safe for a person and live on his skin, intestines, mucous membranes, with a general weakening of the body or impaired immunity, can be pathogenic. At the same time, they damage ("digest") cells and tissues with their enzymes and poison the body with waste products - toxins. All this leads to the development of the disease.

A bacterial infection is characterized by the so-called gate - the way through which it enters the body. As with viruses, there are also many ways in which infection is transmitted. For example, bacteria can enter the body through mucous membranes, insect bites (transmissible) or animals.

Having penetrated the human body, bacteria begin to multiply actively, which will be considered the beginning of a bacterial infection. The clinical manifestations of this disease develop depending on the localization of the microorganism.

Comparison of viral and bacterial infections... For a viral infection, a general damage to the body is characteristic, while a bacterial one most often acts localized. The incubation period for a viral infection is from 1 to 5 days, for a bacterial infection - from 2 to 12 days. Viral infection begins acutely with a rise in temperature to 39 ° C or more. At this moment, general weakness and intoxication of the whole organism is observed. Bacterial infection begins gradually with more severe symptoms and temperatures up to 38 ° C. Sometimes its appearance is preceded by a viral infection, in this case it is customary to speak of the "second wave" of the disease.

Knowing the differences between viral and bacterial infections is primarily necessary due to the fact that these infections are treated in different ways.

If antibiotics are used in the absence of appropriate indications, then resistant bacteria may form. Also, antibiotics often cause side effects, including the development of a violation of the quantitative and qualitative composition of the intestinal microflora. In addition, there is reliable data on an increased risk of bronchial asthma and atopic dermatitis in children who received antibiotics in preschool age.

So remember: Bacterial infections are treated with antibiotics: viral infections are not treated with antibiotics, since these drugs do not work on them.

ARVI and Influenza

Despite the fact that influenza and its varieties are classified as acute respiratory viral infections, in medicine, these diseases are usually isolated from all viral infections.

ARVI - acute respiratory viral infection, including all respiratory diseases with viral etiology. The route of transmission of the infection is airborne, while it spreads quite quickly and affects more than 80% of people who have been in contact with the sick. The reason is the impossibility of the human body to develop immunity to a viral infection, since every year viruses mutate and change.

Almost every person several times (from 4 to 15 times or more) a year suffers ARVI, mainly in the form of mild and subclinical (latent) forms

Signs and symptoms of SARS

most often, the disease develops gradually and begins with general weakness and a runny nose
increased body temperature
headache
the next day after the onset of the disease, a dryish cough may appear, which eventually transforms into a wet (expectorant)

ARVI treatment

antipyretic drugs (coldrex, teraflu, aspirin)
cough and phlegm preparations
anti-inflammatory, decongestant, vasoconstrictor drugs and nasal saline solutions
multivitamins, ascorbic acid
drugs that support and increase immunity (interferon, aflubin, immunal)
drinking plenty of water

Fever... This is an increase in body temperature, without which almost no ARVI can do. As a rule, fever is the reason for the use of antipyretic drugs, but in many cases it is unreasonable, because fever is a defense reaction: many bacteria and viruses die at elevated temperatures. Against this background, the body gives a full-fledged immune response. It has been proven that when the temperature drops to subfebrile (about 37.5 ° C) or normal level, the production of protective factors in the body decreases.

Flu - is caused by the influenza virus and is considered one of the most insidious infectious diseases that spread around the planet in the form of epidemics and pandemics, which annually claim from 250 to 500 thousand human lives.

Currently, scientists have identified more than 2000 varieties of the virus, the most famous of which are H1N1 - swine flu, A / H1N1 - Spanish flu, as well as bird flu, which has become famous all over the world.

Local remedies for the treatment of diseases of the nasopharynx... They can be conditionally divided into several groups: antiseptics (hexoral, stopangin, kameton, inhalipt); antibiotics (bioparox); local anesthetic agents (Tantum Verde) and combined agents with antiseptic and analgesic effects (TeraFlu Lar, Strepsils, Anti-Angin, NovaSept medications from medicinal plants).

Combined agents are more preferable for patients, as they immediately relieve the condition, providing an analgesic effect, and also help to avoid taking antibacterial drugs.

Diseases of the upper respiratory tract are common throughout the world and occur in every fourth inhabitant. These include sore throat, laryngitis, pharyngitis, adenoiditis, sinusitis, and rhinitis. The peak of diseases occurs in the off-season, then cases of inflamed processes take on a massive nature. This is caused by acute respiratory infections or the flu virus. According to statistics, an adult suffers up to three cases of the disease; in a child, inflammation of the upper respiratory tract occurs up to 10 times a year.

There are three main reasons for the development of various kinds of inflammation.

Virus. Influenza strains, rotoviruses, adenoviruses, mumps and measles, when ingested, cause an inflammatory response.
Bacteria. The bacterial infection can be caused by pneumococcus, staphylococcus, mycoplasma, meningococcus, mycobacterium and diphtheria, as well as whooping cough.
Fungus. Candida, aspergillus, actinomycetes cause a local inflammatory process.

Most of these pathogenic organisms are transmitted from humans. Bacteria, viruses are unstable to the environment and practically do not live there. Some strains of the virus or fungi can live in the body, but only manifest themselves when the body's defenses are reduced. Infection occurs during the activation of dormant pathogenic microbes.

Among the main methods of infection should be highlighted:

transmission by airborne droplets;
household way.

Particles of the virus, as well as microbes, penetrate through close contact with an infected person. Transmission is possible by talking, coughing, sneezing. All this is natural in case of diseases of the respiratory tract, because the respiratory tract is the first barrier for pathogenic microorganisms.

Tuberculosis, diphtheria and Escherichia coli often enters the host's body in a household way. Household items and personal hygiene items become the link between a healthy and an infected person. Anyone can get sick, regardless of age, gender, material condition and social status.

Symptoms

The symptoms of upper respiratory tract inflammation are quite similar, with the exception of discomfort and pain, which are localized in the affected area. It is possible to determine the place of inflammation and the nature of the disease based on the symptoms of the disease, but it is possible to confirm the disease and identify the pathogen only after a thorough examination.

All diseases are characterized by an incubation period that lasts from 2 to 10 days, depending on the pathogen.

Rhinitis

Known to everyone as a runny nose, it is an inflammatory process of the nasal mucosa. Typical for rhinitis is exudate in the form of a runny nose, which, when microbes multiply, abundantly leaves. Both sinuses are affected as the infection spreads quickly.
Sometimes rhinitis may not cause a runny nose, but, on the contrary, manifest itself as severe congestion. If, nevertheless, discharge is present, then their nature directly depends on the pathogen. The exudate can be a clear liquid, and sometimes purulent discharge and green color.

Sinusitis

Sinus inflammation goes away as a secondary infection and is manifested by difficulty breathing and a feeling of blockage.
Sinus swelling causes headaches, has a negative effect on the optic nerves, and the sense of smell is impaired. Discomfort and pain in the bridge of the nose indicates a running inflammatory process. The discharge of pus is usually accompanied by fever and fever, as well as general malaise.

Angina

The inflammatory process in the area of \u200b\u200bthe tonsils in the pharynx causes a number of characteristic symptoms:

pain when swallowing;
difficulty eating and drinking;
high temperature;
muscle weakness.

Angina can occur due to the ingestion of both a virus and bacteria. In this case, the tonsils swell, a characteristic plaque appears on them. With purulent tonsillitis, yellow and greenish overlays envelop the palate and mucous membrane of the throat. With a fungal etiology, a plaque of white curdled consistency.

Pharyngitis

Sore throat is manifested by sore throat and dry cough. Breathing may be difficult from time to time. General malaise and low-grade fever are variable. Pharyngitis usually occurs with influenza and acute respiratory infection.

Laryngitis

Inflammation of the larynx and vocal cords also develops against the background of influenza, measles, whooping cough and parainfluenza. Laryngitis is characterized by hoarseness and cough. The mucous membrane of the larynx swells so much that it interferes with breathing. Without treatment, in the form of stenosis of the laryngeal walls or muscle spasm. Symptoms get worse without treatment.

Bronchitis

Inflammation of the bronchi (this is the lower part of the respiratory tract) is characterized by sputum waste or severe dry cough. In addition, general intoxication and malaise.
In the initial stage, symptoms may not appear until the inflammation reaches the nerve processes.

Pneumonia

Inflammation of the lung tissue in the lower and upper parts of the lung, which usually cause pneumococci, always general intoxication, fever and chills. As the cough progresses, pneumonia gets worse, but sputum may appear much later. With a non-infectious nature, symptoms may not appear. Symptoms are similar to a running cold and diseases are not always diagnosed on time.

Therapies

After clarifying the diagnosis, treatment is started in accordance with the general condition of the patient, the cause that caused the inflammation. Three main types of treatment are considered:

pathogenetic;
symptomatic;
etiotropic.

Pathogenetic treatment

It is based on stopping the development of the inflammatory process. For this, immunostimulating drugs are used so that the body can fight the infection itself, as well as auxiliary treatment that suppresses the inflammatory process.

To strengthen the body take:

Anaferon;
Ameksin;
Neovir;
Levomax.

They are suitable for both child and adult. It is pointless to treat diseases of the upper respiratory tract without immune support. If a bacterium has become the causative agent of inflammation of the respiratory system, treatment is carried out with Immudon or Bronchomunal. For individual indications, non-steroidal anti-inflammatory drugs can be used. They relieve general symptoms and inhibit pain syndrome, this is important, especially if you treat a child who
is difficult to tolerate the disease.

Etiotropic method

Based on suppression of the pathogen. It is important to stop the multiplication of the virus and bacteria in the upper sections, as well as to prevent their spread. The main thing is to accurately establish the virus strain and the etiology of pathogenic microbes in order to choose the right regimen and start treatment. Antiviral drugs include:

Remantadine;
Relens;
Arbidol;
Kagocel;
Isoprinosine.

They only help when a virus has caused the disease. If it cannot be killed, as with herpes, you can simply suppress the symptoms.

Bacterial airway inflammation can only be treated with antibacterial drugs, the dosage must be prescribed by a doctor. These drugs are very dangerous if used rashly and can cause irreparable harm to the body.

For a child, such treatment can lead to complications in the future. Therefore, when choosing a drug, special attention is paid to the patient's age, his physiological characteristics, and also a test for the presence of allergic reactions is carried out. Modern pharmacology offers effective drugs for the treatment of macrolides, beta-lactams and fluoroquinolones.

Symptomatic treatment

Since antibacterial or antifungal treatment has a gradual effect in most cases, it is important to suppress the symptoms that cause discomfort to the person. For this, there is symptomatic treatment.

Nasal drops are used to suppress the common cold.
Broad-spectrum anti-inflammatory drugs or topical herbal sprays are used to relieve sore throat and reduce swelling.
Symptoms such as a cough or a sore throat are suppressed with expectorant drugs.

With severe edema of the upper as well as lower parts of the lungs, symptomatic treatment does not always have the desired result. It is important not to use all known treatment methods, but to choose the correct regimen based on the complex elimination of symptoms and the causative agent of inflammation.

Inhalation will help to relieve swelling, suppress cough and sore throat, and also stop a runny nose. Alternative treatments can improve breathing and prevent oxygen starvation.

The main thing is not to self-medicate, but to undergo it under the supervision of a specialist and follow all his recommendations.

Statistics say that respiratory diseases in children are the most common reason for seeking medical help. Their share is approximately 70% in the structure of the overall child morbidity. Respiratory problems can occur from the first seconds after birth and throughout childhood.

Why are children's respiratory tract susceptible to disease? Which departments are affected more often? What do you need to know in order to protect your baby from serious, sometimes fatal complications? Doctors are often asked these questions.

The child's airways are fully mature by the beginning of puberty. Until that time, there are differences in the respiratory system of children and adults. The main features in a small patient are as follows:

The child's nasal passages are narrowed, and the lower nasal passage is practically absent until the age of 4.

The mucous membrane of the nose is delicate, rich in blood vessels, which expand during inflammation.
The lymphoid tissue of the nasopharynx is more developed, often hypertrophied, which makes breathing difficult.
The larynx and glottis are narrowed, the ligaments are shortened.
The lung tissue has an increased density.
The depth of breathing is less.
Respiratory muscles are poorly developed.
Physiologically, the frequency of respiratory movements is increased.
The breathing pattern in newborns is unstable.
The bronchi are more prone to narrowing of the lumen compared to adults.

This is a prerequisite for frequent colds of the upper respiratory tract, bronchitis and pneumonia.

Classification

The classification can be based on the causes of respiratory diseases in childhood. Among them stand out:

Infections (viruses, microbes, fungi).
Allergies and immunological deficiencies.
Aspiration.
Foreign bodies of the respiratory tract.
Developmental defects.

By localization of the pathological process, there are:

Diseases of the upper respiratory tract (rhinitis, pharyngitis, laryngitis, tonsillitis, tonsillitis);
Diseases of the lower respiratory tract (tracheitis, bronchitis, pneumonia, pleurisy).

The larynx occupies an intermediate position, so some people attribute laryngitis to diseases of the lower respiratory tract.

Respiratory diseases in children are characterized by the transition from one form of the disease to another.

For example, starting with rhinitis, the disease under unfavorable conditions turns into bronchitis or pneumonia. In this case, living conditions, ecology, the nature of the child's diet, hypovitaminosis and the above-mentioned structural features of the respiratory system play a significant role.

Common symptoms

The main symptoms indicating problems in the baby's respiratory system are as follows:

Difficulty nasal breathing.
Nasal congestion.
Elevated temperature.
Increased breathing rate.
Decreased breathing depth.
Dyspnea.
Cough.
Sputum separation.
Changes in skin color in the area of \u200b\u200bthe nasolabial triangle - the appearance of a bluish tint (cyanosis).

The combination of symptoms varies depending on the involvement of various parts of the respiratory system in the disease.

At the first stage of the child's illness, a pediatrician is observed; in the future, a pulmonologist, an allergist, an ENT specialist can be involved in the treatment process.

Diagnostics

General diagnostic methods are used to make a diagnosis, starting with asking the parents and the child about the symptoms and the onset of the disease. Examination reveals cyanosis of the nasolabial triangle, the presence of discharge from the nose, the degree of participation of the respiratory muscles in the act of breathing, difficulty in inhaling or exhaling.

Inspection of the nasal cavity is carried out using a rhinoscope. Percussion (tapping) and auscultation (listening) of the lungs give an idea of \u200b\u200bthe state of the bronchi and lung tissue. X-ray research method is one of the most informative. Laboratory diagnostics include a complete blood count, bacteriological examination of the separated sputum, allergological and immunological tests.

Features of lung diseases in newborns

In newborns, more often in those born prematurely, there are congenital malformations affecting individual lobes or the entire lung. Distinguish:

Agenesis.
Aplasia.
Lung hypoplasia.

With agenesis, the absence of bronchus and lung is observed, with aplasia, the stump of the bronchus is preserved, but there is no lung tissue. Hypoplasia is characterized by underdevelopment of the bronchus and lung. The prognosis for congenital defects is serious, often there is a combination with other malformations.

Lung atelectasis

In premature newborns, atelectasis of the lungs is often found - areas of lung tissue that did not expand or collapse after the first breath. This is due to the immaturity of the infant's respiratory center, as well as insufficient production of surfactant, a special substance that keeps the alveoli in a straightened state. In the absence of infection, atelectasis within the lung segment is straightened within a few days, scattered - within a month. The child is in an incubator, oxygen is supplied, drug therapy, if indicated, artificial lung ventilation or assisted breathing.

Fatal diseases

In childbirth, immediately and 5 minutes after birth, the condition of the newborn is assessed using the Virginia Apgar scale, one of the criteria of which is the assessment of breathing. If there is no loud cry, the baby does not breathe, or there are weak single breaths, then they say that the child has asphyxia. It occurs acutely during childbirth, for example, when the umbilical cord knots or twisted around the umbilical cord in the neck of the baby. Or it is a continuation of chronic oxygen starvation of the fetus during pregnancy, for example, with anemia in the mother. A child with asphyxiation undergoes resuscitation measures, starting with the sanitation of the respiratory tract from mucus, amniotic fluid and meconium.

Congenital bronchiectasis can be one of the causes of asphyxia. These are saccular bronchial dilatations. With unexpressed single bronchiectosis, the clinic is not observed, but the child has a tendency to colds in the future. In severe cases, death from asphyxia occurs on the first day.

Formidable pathology - congenital interstitial fibrosis. Its reasons have not been studied. It causes swelling, thickening, or thinning of the septa inside the lung. The symptoms of respiratory distress begin to appear in the first month after birth. Radiography helps in diagnosis. Symptomatic therapy is 70% ineffective, the child dies.

Hyaline membrane disease is a common cause of death among preterm infants. The essence of the disease is that on the inner surface of the air bubbles - alveoli and thin bronchioles, a hyaline-like substance begins to be deposited totally or in clumps.

Congenital lung cysts are rare. Their size affects the forecast.

Upper respiratory tract diseases

A person encounters diseases from this classification very often. In particular, there has not yet been a single case in the practice of a pediatrician so that for at least 1 year the child has never complained of a runny nose. Therefore, it is worth considering in more detail the diseases of the upper respiratory tract.